How to cite: Finkelstein SE. Fireside Chat – Immunotherapy for Bladder Cancer. Grand Rounds in Urology. November 2025. Accessed Jan 2026. https://grandroundsinurology.com/fireside-chat-immunotherapy-for-bladder-cancer/
Summary
Steven E. Finkelstein, MD, DABR, FACRO, Director of the Center of Advanced Radiation Excellence and Director of Radiation Oncology Research at Associated Medical Professionals, Syracuse, New York, and Christopher Pieczonka, MD, Chief Executive Officer of Associated Medical Professionals of NY, discuss the evolving role. Dr. Pieczonka explains that immunotherapy for this disease encompasses both systemic therapy and intravesical therapy. Bacillus Calmette-Guérin (BCG) has been the standard intravesical immunotherapy for non-muscle-invasive bladder cancer for decades, but its limitations have driven the exploration of newer agents. BCG provides only partial efficacy, and recurrence in BCG-unresponsive patients remains a concern.
Dr. Pieczonka notes the recent approval of two FDA-authorized intravesical immunotherapies. One agent is given with BCG to enhance its efficacy, while the other is a viral vector-based therapy administered on a quarterly basis. Both approaches aim to reduce the risk of recurrence and achieve durable responses in patients who are BCG-unresponsive. He emphasizes that these treatments are feasible in community urology practices, with manageable toxicity profiles comparable to BCG. However, cost and reimbursement challenges pose significant barriers to widespread adoption.
Dr. Finkelstein raises the question of combining immunotherapy with radiation. He highlights that radiation has historically been applied in muscle-invasive disease, but not in the non-muscle-invasive setting. He suggests that coupling radiation with emerging immunotherapeutic agents may represent an important future research direction. He stresses the need for coordinated resources and funding to explore this potential.
This talk offers insight into current immunotherapy options for bladder cancer, practical considerations in community practice, and promising future strategies that combine radiation and immunotherapy.
ABOUT THE AUTHOR
Steven E. Finkelstein, MD, FACRO, is the Director of the Center of Advanced Radiation Excellence, and Director of Radiation Oncology Research for Associated Medical Professionals in Syracuse, New York. His interests include the research of a variety of cancers, busting radiation driven, and personalized systemic therapy. He holds three international patents in the field of cutting edge technologies.
Dr. Finkelstein received his medical degree from the University of Michigan Medical School, graduating cum laude eruditions causa. He then joined the National Cancer Institute, National Institutes of Health as a Clinical Associate. He completed both a Surgical Oncology Fellowship as well as a Clinical Immunotherapy Fellowship, and an additional radiation oncology residency.
Dr. Finkelstein served a residency in General Surgery at Washington University in Saint Louis, Missouri, as well as fellowships in Biologic Immunotherapy, Clinical Cancer, and Surgical Oncology at the Surgery Branch of the National Cancer Institute in Bethesda, Maryland. He is a member of the American College of Radiation Oncology, the American Medical Association, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, the Radiological Society of North America, and the Radiation Therapy Oncology Group.
He has served as a Co-Chair on the NRG Immunotherapy Committee, Co-Chair of the 2018-2019 American College of Radiation Oncology (ACRO) Scientific Program Committee, and Chair of the SWOG Radiation STG Committee. He currently serves on the Board of Chancellors for ACRO. Dr. Finkelstein has also served as National Director of Translational Research Consortium (TRC), the cutting-edge therapy arm of 21st Century Oncology in Scottsdale, Arizona. Inspired by his grandmother, a cancer patient, he became a dedicated cancer surgeon who found that radiation therapy could sometimes do for his patients what surgery could not.
Christopher Pieczonka, MD, is the Chief Executive Officer for Associated Medical Professionals, and Director of Clinical Research at U.S. Urology Partners in Syracuse, New York. Dr. Pieczonka specializes in advanced prostate and bladder cancer.
